› Forums › Cutaneous Melanoma Community › Surgery by dermatologist or surgeon? Which is better?
- This topic has 18 replies, 4 voices, and was last updated 12 years, 7 months ago by
jax2007gxp.
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- October 5, 2011 at 3:07 pm
I'm brand new to this forum…
I'm brand new to this forum… was just diagnosed with a malignant melanoma in situ this morning. My dermatologist is ready to do surgery next week, to excise a wider area of skin where the mole was. However, oddly enough, I had surgery a year and a half ago for a different type of cancer, and that surgeon also specializes in melanoma. Would it be better to have my dermatologist do this minor surgery, or to go back to my previous surgeon? Does it matter? I'm guessing that because it's only "in situ" (thank god for that), that it would be okay to just have my dermatologist do it… just looking for any opinions or info you might have. It's really weird to me to now have to start Googling and gathering info about THIS type of cancer, after I've been so immersed in forums for my OTHER type of cancer… life is so strange.
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- October 5, 2011 at 3:20 pm
Sorry you have to join us here, but in situ is the best diagnosis you can have in a place like this. Some dermatologist won't do the WLE (wide local excision). They send you to a surgeon. Others do lots of them. I've had 2 WLE by just a derm, and 5 by a melanoma specialist. In truth, at least for me, there isn't much difference. If this dermatologist does WLEs all the time, then I see no reason not to have him do this. If you feel more comfortable with the specialist, go there. If this is in a very visible location (face), you might even consider a plastic surgeon. All you really want is to make sure whomever does the surgery, they achieve the necessary 5mm margins. That's the most important thing. Go with whomever makes you feel the most comfortable! And congrats on catching this lesion very early.
Best wishes,
Janner
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- October 5, 2011 at 10:06 pm
Hi,
Janner gave you great advice. I would say the same. I have had many moles removed, some melanoma, some not, and the ones that were, required a wider excision. I've had both my oncology surgeon who specializes in melanoma do the wider excision and I have had the dermatologist, who specializes in melanoma. I have let the docs make that call….some the dermatologist has preferred because of location, previous surgeries in the area, and other factors have influenced my dermatologist's decisions. Fortunately, my medical care for cancer is all at the same major medical facility (Dartmouth Hitchcock Medical Center in NH), and so they have the electronic medical record and all providers can see all the notes and surgery reports, labs, issues, etc. Plus they talk to each!!
I wish you a long and fabulous life! just get the wider excision done and be vigilant about changes in your skin and get changes checked out asap from now on!!
Vermont_Donna, stage 3a, NED
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- October 5, 2011 at 10:06 pm
Hi,
Janner gave you great advice. I would say the same. I have had many moles removed, some melanoma, some not, and the ones that were, required a wider excision. I've had both my oncology surgeon who specializes in melanoma do the wider excision and I have had the dermatologist, who specializes in melanoma. I have let the docs make that call….some the dermatologist has preferred because of location, previous surgeries in the area, and other factors have influenced my dermatologist's decisions. Fortunately, my medical care for cancer is all at the same major medical facility (Dartmouth Hitchcock Medical Center in NH), and so they have the electronic medical record and all providers can see all the notes and surgery reports, labs, issues, etc. Plus they talk to each!!
I wish you a long and fabulous life! just get the wider excision done and be vigilant about changes in your skin and get changes checked out asap from now on!!
Vermont_Donna, stage 3a, NED
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- October 5, 2011 at 10:06 pm
Hi,
Janner gave you great advice. I would say the same. I have had many moles removed, some melanoma, some not, and the ones that were, required a wider excision. I've had both my oncology surgeon who specializes in melanoma do the wider excision and I have had the dermatologist, who specializes in melanoma. I have let the docs make that call….some the dermatologist has preferred because of location, previous surgeries in the area, and other factors have influenced my dermatologist's decisions. Fortunately, my medical care for cancer is all at the same major medical facility (Dartmouth Hitchcock Medical Center in NH), and so they have the electronic medical record and all providers can see all the notes and surgery reports, labs, issues, etc. Plus they talk to each!!
I wish you a long and fabulous life! just get the wider excision done and be vigilant about changes in your skin and get changes checked out asap from now on!!
Vermont_Donna, stage 3a, NED
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- October 5, 2011 at 3:20 pm
Sorry you have to join us here, but in situ is the best diagnosis you can have in a place like this. Some dermatologist won't do the WLE (wide local excision). They send you to a surgeon. Others do lots of them. I've had 2 WLE by just a derm, and 5 by a melanoma specialist. In truth, at least for me, there isn't much difference. If this dermatologist does WLEs all the time, then I see no reason not to have him do this. If you feel more comfortable with the specialist, go there. If this is in a very visible location (face), you might even consider a plastic surgeon. All you really want is to make sure whomever does the surgery, they achieve the necessary 5mm margins. That's the most important thing. Go with whomever makes you feel the most comfortable! And congrats on catching this lesion very early.
Best wishes,
Janner
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- October 5, 2011 at 3:20 pm
Sorry you have to join us here, but in situ is the best diagnosis you can have in a place like this. Some dermatologist won't do the WLE (wide local excision). They send you to a surgeon. Others do lots of them. I've had 2 WLE by just a derm, and 5 by a melanoma specialist. In truth, at least for me, there isn't much difference. If this dermatologist does WLEs all the time, then I see no reason not to have him do this. If you feel more comfortable with the specialist, go there. If this is in a very visible location (face), you might even consider a plastic surgeon. All you really want is to make sure whomever does the surgery, they achieve the necessary 5mm margins. That's the most important thing. Go with whomever makes you feel the most comfortable! And congrats on catching this lesion very early.
Best wishes,
Janner
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- October 5, 2011 at 10:09 pm
Please make sure you do your research on the derm. Ask lots of questions about his/her experience. Don't be afraid of getting a second opinion from the mel specialist.
My WLE was on my thigh. I didn't know a thing about melanoma at the time. If I had, I would have immediately transferred to a specialist. My surgery was performed in the derm's office. Not only did I contract MRSA, but I also developed a complication called pyoderma granulosum, which was possibly my body reacting to the MRSA. Once you have had either of these, you are at higher risk of having them occur again. I shared this fear with my surgeon prior to my lymph node dissection last month and he wasn't concerned in the least. He just started me on antibiotics the day of surgery. I am 3+ weeks post-op with no complications whatsoever!
Bottom line…make sure you are educated so you can be comfortable. Good luck and all the best to you!
Jacki
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- October 5, 2011 at 10:09 pm
Please make sure you do your research on the derm. Ask lots of questions about his/her experience. Don't be afraid of getting a second opinion from the mel specialist.
My WLE was on my thigh. I didn't know a thing about melanoma at the time. If I had, I would have immediately transferred to a specialist. My surgery was performed in the derm's office. Not only did I contract MRSA, but I also developed a complication called pyoderma granulosum, which was possibly my body reacting to the MRSA. Once you have had either of these, you are at higher risk of having them occur again. I shared this fear with my surgeon prior to my lymph node dissection last month and he wasn't concerned in the least. He just started me on antibiotics the day of surgery. I am 3+ weeks post-op with no complications whatsoever!
Bottom line…make sure you are educated so you can be comfortable. Good luck and all the best to you!
Jacki
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- October 5, 2011 at 10:09 pm
Please make sure you do your research on the derm. Ask lots of questions about his/her experience. Don't be afraid of getting a second opinion from the mel specialist.
My WLE was on my thigh. I didn't know a thing about melanoma at the time. If I had, I would have immediately transferred to a specialist. My surgery was performed in the derm's office. Not only did I contract MRSA, but I also developed a complication called pyoderma granulosum, which was possibly my body reacting to the MRSA. Once you have had either of these, you are at higher risk of having them occur again. I shared this fear with my surgeon prior to my lymph node dissection last month and he wasn't concerned in the least. He just started me on antibiotics the day of surgery. I am 3+ weeks post-op with no complications whatsoever!
Bottom line…make sure you are educated so you can be comfortable. Good luck and all the best to you!
Jacki
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- October 6, 2011 at 1:33 am
Thank you, Janner, Donna, and Jacki!
Jacki, that's a scary story. I'm now leaning towards seeing if my previous surgeon can do this melanoma excision…
A couple years ago, I had a SNB in my left armpit (along with a lumpectomy for breast cancer). The melanoma is on my left lateral thigh. I know that having that SNB put me at lifelong risk for lymphedema… is that a reason to have the melanoma excision done in an OR, by my surgeon, instead of at the dermatologist's office? A big lymphedema prevention strategy is, of course, practicing meticulous skin care and doing everything possible to avoid skin infections. But I thought my armpit SNB put me at risk for developing lymphedema in my left ARM… could a wound on my left LEG really be a risk?
Oh, gosh, there's just so much to learn, with a new cancer diagnosis. I've been so immersed in the online breast cancer world, and now I have a new cancer world to explore… no fun. But thank you for your help.
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- October 6, 2011 at 3:11 am
A WLE for a stage I lesion is unlikely to cause an issue with lymphedema – and even then, it would only affect your left groin and not your arm. The SNB has a higher risk and the LND (lymph node dissection) is a much higher risk. Jacki's story sounds very scary but it isn't at all usual. I've never even had a hint at an infection in 7 WLE's and have known many stage I warriors with similar stories to mine. All my excisions were done in an office setting, not a hospital. Still, in the end, it is YOU who must be comfortable with your decision. I, personally, try to avoid hospitals and all the infections found there and was more comfortable in a casual office situation. I drove myself to and from all my excisions with no problems. I just planned to be home before the lidocaine wore off.
Best wishes,
Janner
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- October 6, 2011 at 3:11 am
A WLE for a stage I lesion is unlikely to cause an issue with lymphedema – and even then, it would only affect your left groin and not your arm. The SNB has a higher risk and the LND (lymph node dissection) is a much higher risk. Jacki's story sounds very scary but it isn't at all usual. I've never even had a hint at an infection in 7 WLE's and have known many stage I warriors with similar stories to mine. All my excisions were done in an office setting, not a hospital. Still, in the end, it is YOU who must be comfortable with your decision. I, personally, try to avoid hospitals and all the infections found there and was more comfortable in a casual office situation. I drove myself to and from all my excisions with no problems. I just planned to be home before the lidocaine wore off.
Best wishes,
Janner
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- October 6, 2011 at 3:11 am
A WLE for a stage I lesion is unlikely to cause an issue with lymphedema – and even then, it would only affect your left groin and not your arm. The SNB has a higher risk and the LND (lymph node dissection) is a much higher risk. Jacki's story sounds very scary but it isn't at all usual. I've never even had a hint at an infection in 7 WLE's and have known many stage I warriors with similar stories to mine. All my excisions were done in an office setting, not a hospital. Still, in the end, it is YOU who must be comfortable with your decision. I, personally, try to avoid hospitals and all the infections found there and was more comfortable in a casual office situation. I drove myself to and from all my excisions with no problems. I just planned to be home before the lidocaine wore off.
Best wishes,
Janner
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- October 6, 2011 at 3:45 am
Please don't depend on my one experience to make your decision. You really should talk to your derm and possibly your mel specialist and see where you feel most comfortable. Keep in mind, the derm who did my WLE also misdiagnosed my extremely swollen lymph nodes as an injured tendon in my groin. Luckily, I didn't let myself believe her for more than a few weeks or my condition would have continued to get worse. But, do your research, tell your docs your concerns, ask about experience and previous results then make a decision with which you are comfortable. I wish I had been more like you 18 months ago.
Jacki
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- October 6, 2011 at 3:45 am
Please don't depend on my one experience to make your decision. You really should talk to your derm and possibly your mel specialist and see where you feel most comfortable. Keep in mind, the derm who did my WLE also misdiagnosed my extremely swollen lymph nodes as an injured tendon in my groin. Luckily, I didn't let myself believe her for more than a few weeks or my condition would have continued to get worse. But, do your research, tell your docs your concerns, ask about experience and previous results then make a decision with which you are comfortable. I wish I had been more like you 18 months ago.
Jacki
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- October 6, 2011 at 3:45 am
Please don't depend on my one experience to make your decision. You really should talk to your derm and possibly your mel specialist and see where you feel most comfortable. Keep in mind, the derm who did my WLE also misdiagnosed my extremely swollen lymph nodes as an injured tendon in my groin. Luckily, I didn't let myself believe her for more than a few weeks or my condition would have continued to get worse. But, do your research, tell your docs your concerns, ask about experience and previous results then make a decision with which you are comfortable. I wish I had been more like you 18 months ago.
Jacki
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- October 6, 2011 at 1:33 am
Thank you, Janner, Donna, and Jacki!
Jacki, that's a scary story. I'm now leaning towards seeing if my previous surgeon can do this melanoma excision…
A couple years ago, I had a SNB in my left armpit (along with a lumpectomy for breast cancer). The melanoma is on my left lateral thigh. I know that having that SNB put me at lifelong risk for lymphedema… is that a reason to have the melanoma excision done in an OR, by my surgeon, instead of at the dermatologist's office? A big lymphedema prevention strategy is, of course, practicing meticulous skin care and doing everything possible to avoid skin infections. But I thought my armpit SNB put me at risk for developing lymphedema in my left ARM… could a wound on my left LEG really be a risk?
Oh, gosh, there's just so much to learn, with a new cancer diagnosis. I've been so immersed in the online breast cancer world, and now I have a new cancer world to explore… no fun. But thank you for your help.
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- October 6, 2011 at 1:33 am
Thank you, Janner, Donna, and Jacki!
Jacki, that's a scary story. I'm now leaning towards seeing if my previous surgeon can do this melanoma excision…
A couple years ago, I had a SNB in my left armpit (along with a lumpectomy for breast cancer). The melanoma is on my left lateral thigh. I know that having that SNB put me at lifelong risk for lymphedema… is that a reason to have the melanoma excision done in an OR, by my surgeon, instead of at the dermatologist's office? A big lymphedema prevention strategy is, of course, practicing meticulous skin care and doing everything possible to avoid skin infections. But I thought my armpit SNB put me at risk for developing lymphedema in my left ARM… could a wound on my left LEG really be a risk?
Oh, gosh, there's just so much to learn, with a new cancer diagnosis. I've been so immersed in the online breast cancer world, and now I have a new cancer world to explore… no fun. But thank you for your help.
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Tagged: cutaneous melanoma
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